title: Pericarbon pericardial valve prosthesis: midterm results of the aortic valve replacement.
abstract: This clinical study was undertaken to verify the encouraging results of experimental studies regarding a new pericardial bioprosthesis. From May 1989 to November 1993, 204 patients underwent an aortic valve replacement with the Pericarbon (Sorin Biomedica Cardio S.p.A., Saluggia, Italy) prosthesis. A follow-up was 100% complete and extended to 65 months (total 408 patient-years, average 2.0+/-1.4 years). Mean age at the operation was 75.1+/-5.5 years and 96% were in NYHA clinical stage III or IV. There were 86 men and 118 women; 73 patients had an isolated aortic valve disease, 131 had a concomitant cardiosurgical procedure (coronary artery bypass grafting in 106 patients). The operative mortality (30-day mortality) rate was 11.8% (24/204). There were 24 late deaths (5.9+/-1.2% patient-year). The actuarial probability of survival was 68+/-5% at 5 years. Four patients died of valve-related causes (one thromboembolic complication, two endocarditis, one anticoagulant-related hemorrhage). Actuarial rate of freedom from valve-related death was 95+/-3% at 5 years. Valve-related morbidity included seven thromboembolic episodes (1.7% patient-year), four anticoagulant-related complications (0.9% patient-year), three endocarditis (0.7% patient-year) and one reoperation (0.2% patient-year). After 5 years freedom from thromboembolic events was 83+/-7%, from anticoagulant-related hemorrhage 96+/-2%, from endocarditis 97+/-2%, and from reoperation 99+/-1%. Echocardiographic study performed in 30 patients showed a paraprosthetic leak in four patients, a central leak in two, and cusp thickening in another three. The clinical data showed that the Pericarbon prosthesis has valve-related morbidity. The echocardiographic results suggest that the prosthesis can undergo a pathologic process during the first 5 years after implantation. This makes it necessary to continue the follow-up and include the larger number of patients in the echocardiographic investigation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
authors.forename: J W
authors.initials: JW
authors.lastname: Borowiec
authors.forename: T W
authors.initials: TW
authors.lastname: Dubiel
authors.forename: H E
authors.initials: HE
authors.lastname: Hansson
authors.forename: J
authors.initials: J
authors.lastname: Landelius
authors.forename: S O
authors.initials: SO
authors.lastname: Nyström
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects; D002114:Calcinosis / Q000601:surgery; D002244:Carbon; D002423:Cause of Death; D001026:Coronary Artery Bypass; D004452:Echocardiography; D004696:Endocarditis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium; D019106:Postoperative Hemorrhage / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D015996:Survival Rate; D013784:Textiles; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D002244:Carbon